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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 10 of 50

181.

Respiratory Syncytial Virus (RSV) is the MOST common virus responsible for causing which of the following pediatric illnesses?

  • Bronchiolitis

  • Pneumonia

  • Epiglottitis

  • Acute laryngotracheobronchitis

Correct answer: Bronchiolitis

Bronchiolitis is a viral infection of the lower respiratory tract that causes inflammation of the smaller airways. The respiratory syncytial viruses are the most common organisms responsible for bronchiolitis infection. Symptoms of bronchiolitis include rhinorrhea, respiratory difficulty, wheezing, coughing, pharyngitis, and retraction of the intercostal and subcostal muscles.

Pneumonia is an infection that inflames the air sacs (alveoli) in one or both lungs. Various organisms, including bacteria, viruses, and fungi, can cause pneumonia. Epiglottitis is a potentially life-threatening condition characterized by inflammation of the epiglottis. Historically, Haemophilus influenzae type b (Hib) bacteria was the most common cause of epiglottitis among children. However, with the introduction of the Hib vaccine, the incidence of epiglottitis caused by this bacterium has significantly decreased. Now, epiglottitis can affect both adults and children and can be caused by a variety of factors. Acute laryngotracheobronchitis, commonly known as croup, is a viral infection that causes swelling and inflammation of the larynx, trachea, and bronchi. Croup is most often caused by a virus, usually the parainfluenza virus.

182.

Which of the following clotting profiles assesses the common pathway and the intrinsic coagulation pathway?

  • Activated partial thromboplastin time

  • Prothrombin time

  • Thrombin time

  • Bleeding time

Correct answer: Activated partial thromboplastin time

Activated Partial Thromboplastin Time (aPTT) is a test used to measure the time it takes for blood to clot. It evaluates the intrinsic and common pathways of the coagulation cascade. The normal range is generally 25–35 seconds, but it can vary slightly depending on the laboratory. 

Prothrombin time assesses the common pathway and the extrinsic coagulation pathway. Thrombin time assesses how long it takes for thrombin to convert fibrinogen into a fibrin clot, and bleeding time assesses platelet function.

183.

If a patient is demanding and angry, they are in which stage of crisis?

  • Disorganization

  • Shock

  • Reorganization

  • Resolution

Correct answer: Disorganization

An individual is in the disorganization stage of a crisis when they are demanding and angry.

The stages of crisis are as follows:

  1. Shock: Disbelief
  2. Disorganization: Demanding and angry
  3. Reorganization: Difficulty making decisions
  4. Resolution: Accepts the crisis

184.

A 29-year-old pregnant woman at 34 weeks gestation presents with painless vaginal bleeding. Her ultrasound shows placenta previa. What is the PRIORITY intervention to minimize maternal and fetal risks?

  • Ensure the patient is on bedrest and monitor for signs of labor

  • Prepare for immediate delivery

  • Administer magnesium sulfate to prevent seizures

  • Schedule an immediate induction of labor to avoid complications

Correct answer: Ensure the patient is on bedrest and monitor for signs of labor

The priority intervention for a patient with placenta previa is to ensure she is on bedrest and monitor for signs of labor. This approach helps minimize the risk of further bleeding and preterm labor while allowing the pregnancy to progress as long as safely possible. Bedrest reduces physical activity that might trigger bleeding or contractions.

Preparing for immediate delivery is not appropriate unless there are signs of maternal or fetal distress. Delivery decisions should be based on the clinical condition and gestational age. Administering magnesium sulfate to prevent seizures is relevant in the context of preeclampsia or eclampsia, not placenta previa. The condition does not involve seizures but is related to the abnormal placental location. Immediate induction of labor is contraindicated in placenta previa as it increases the risk of severe bleeding and complications. Delivery should be carefully planned, often via cesarean section at a later stage when it is safer for the mother and baby.

185.

The nurse is administering nitroprusside (Nipride) to a patient who is experiencing a hypertensive emergency. Which consideration is incorrect for administering this medication?

  • Titration should be rapid to slow the progression of end-organ damage

  • An arterial line will probably be indicated

  • The onset of the medication will be very rapid

  • The blood pressure should not be reduced by more than 25% in the first two hours

Correct answer: Titration should be rapid to slow the progression of end-organ damage

Because the effects of nitroprusside have such a rapid onset, it should be titrated slowly to avoid dropping blood pressure too quickly. An arterial line will likely be indicated to track blood pressure changes in real time. It is important to avoid reducing blood pressure by more than 25% in the first two hours to avoid complications that can occur with rapid reductions in blood pressure.

186.

Which of the following herbal supplements, when taken in conjunction with an SSRI, can cause serotonin syndrome, a potentially fatal drug reaction?

  • St. John's wort

  • Ginkgo biloba

  • Echinacea

  • Ginseng

Correct answer: St. John's wort 

St. John's wort is an herbal supplement that is often used by patients with depression, as it is known to elevate mood. However, the fact that it is "natural" does not mean it cannot cause harm. Serotonin syndrome is a potentially fatal drug reaction that occurs when high levels of serotonin accumulate. Serotonin syndrome can occur when St. John's wort is combined with a prescribed Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant, which essentially causes "double dosing." St. John's wort also has the potential to induce mania. For this reason, among others, patients should always be asked about their use of herbal supplements.

Ginkgo biloba enhances mental acuity. Echinacea has immune-stimulating properties, and ginseng has been used in alternative medicine for many different purposes.

187.

Which of the following drug classifications is LEAST likely to help control physical and emotional pain and discomfort for patients who have gastroenteritis?

  • Antidiarrheals

  • Antiemetics

  • Antispasmodics

  • Anxiolytics

Correct answer: Antidiarrheals

Antidiarrheals are not recommended to help a gastroenteritis patient control pain and discomfort because they prevent excretion of a microbe that may be the cause of the gastroenteritis. Antiemetics, antispasmodics, and anxiolytics are all used to help a gastroenteritis patient control pain and discomfort. Antibiotics are generally not effective, as gastroenteritis is most commonly viral in etiology.

188.

A patient has been informed that they are terminally ill and have only a few months to live. However, the patient is acting as if they were never given this information and is living as they did before receiving this news. 

What type of psychological defense mechanism is the patient using?

  • Denial

  • Suppression

  • Repression

  • Rationalization

Correct answer: Denial

The patient is using denial as they are treating a reality factor as though it doesn't exist, because they are unable to accept reality. Denial, by definition, is the refusal to accept fact in order to avoid dealing with painful feelings. In this case, refusing to accept a terminal illness diagnosis is demonstrated as denial.

Suppression is when a patient deliberately forgets painful thoughts or feelings. Repression is when a patient involuntarily forgets painful thoughts or feelings. Rationalization is when a patient tries to justify their feelings or motives by offering a socially acceptable explanation.

189.

A 77-year-old male with a history of Chronic Obstructive Pulmonary Disease (COPD) presents to the emergency department with a productive cough with green sputum, wheezing, and increased shortness of breath. 

Which of the following actions is the MOST appropriate initial step in managing this patient?

  • Administer inhaled short-acting beta-agonists and assess oxygen saturation

  • Initiate antibiotic therapy STAT

  • Administer high-flow oxygen to achieve SpO2 of 98%–100%

  • Perform a spirometry test to confirm COPD exacerbation

Correct answer: Administer inhaled short-acting beta-agonists and assess oxygen saturation

This approach addresses immediate respiratory distress and allows for assessment of the need for further oxygen therapy, which must be carefully titrated to avoid hypercapnia. Albuterol is the bronchodilator of choice, along with nebulized anticholinergics, such as ipratropium bromide. 

While antibiotics may be necessary for bacterial infections, they are not the first line of treatment without confirming the cause of the exacerbation. High-flow oxygen can worsen hypercapnia in COPD patients. Oxygen therapy should be carefully titrated. Spirometry is not typically performed during an acute exacerbation due to the patient's distress and the urgency of treatment.

190.

What is the difference between heatstroke and heat exhaustion?

  • Heatstroke is typically a problem with the body's thermoregulation system, whereas heat exhaustion is related to fluid and electrolyte loss

  • Heatstroke is thought to be less life-threatening than heat exhaustion

  • Heat exhaustion generally occurs when the body temperature reaches 99.5–100.5°F (37.5–38°C), whereas heatstroke occurs at temperatures of 100.5°F (38°C) and above

  • Heat exhaustion occurs more often in the very young, whereas heatstroke occurs more often in the elderly

Correct answer: Heatstroke is typically a problem with the body's thermoregulation system, whereas heat exhaustion is related to fluid and electrolyte loss

Body temperatures may fluctuate, but there is no specific temperature at which these illnesses are diagnosed. With heat exhaustion, core body temperature is generally found to be normal or elevated (98.6–111.2°F or 37–44°C). With heatstroke, hyperthermia is present with core body temperatures found to be greater than 105.8°F (41°C). Heatstroke is more serious than heat exhaustion. Both young and old are susceptible to heatstroke and heat exhaustion.

191.

A 66-year-old female patient presents with acute epigastric pain radiating to her back, hypotension with a blood pressure of 90/60 mmHg, and diaphoresis. 

What is the LEAST likely cause of her symptoms?

  • Cholecystitis

  • Acute pancreatitis

  • Peptic Ulcer Disease (PUD)

  • Acute Coronary Syndrome (ACS)

Correct answer: Cholecystitis

Cholecystitis typically presents with right upper quadrant pain, often radiating to the right shoulder or back, but it is less likely to cause hypotension unless there is a severe systemic infection or perforation, making it the least likely cause of the given symptoms.

Acute pancreatitis can cause severe epigastric pain radiating to the back, hypotension due to dehydration or systemic inflammatory response, and diaphoresis. Peptic Ulcer Disease (PUD) can also present with epigastric pain and, if there is a perforation or significant bleeding, hypotension and diaphoresis. However, it is more commonly associated with upper gastrointestinal bleeding and anemia. Acute Coronary Syndrome (ACS) can present with epigastric pain, hypotension, and diaphoresis, especially in women, who may have atypical presentations.

192.

Which of the following symptoms is LEAST likely to be expected in a patient who develops pericarditis? 

  • Chest pain with a gradual onset

  • Chest pain unrelieved by rest or nitroglycerin 

  • Friction rub present with auscultation

  • Tachypnea 

Correct answer: Chest pain with a gradual onset

Chest pain is common with pericarditis but generally has a rapid onset, not a gradual onset. The pain may be dull or sharp and is often pleuritic in nature. Pericardial chest pain is exacerbated by activity, lying supine, and inspiration. It is alleviated by sitting upright and leaning forward but is unrelieved by rest or nitroglycerin. A pericardial friction rub present with auscultation and tachypnea are both expected symptoms of pericarditis.

193.

A 34-year-old male patient presents with an Achilles tendon rupture. What is the MOST appropriate immediate management step in the emergency department?

  • Immobilize the ankle and refer to an orthopedic specialist

  • Administer intravenous antibiotics 

  • Prescribe oral steroids for inflammation

  • Perform immediate surgical repair

Correct answer: Immobilize the ankle and refer to an orthopedic specialist

Immediate management of an Achilles tendon rupture includes immobilizing the ankle in a plantar flexed position to reduce tension on the tendon and referring the patient to an orthopedic specialist for further evaluation and management, which may include surgical repair.

Intravenous antibiotics are not indicated unless there is an open wound or infection. Immediate surgical repair is not within the scope of emergency department management and requires orthopedic surgical consultation and planning. Oral steroids do not address the primary issue of tendon rupture and can impair healing.

194.

Overdose of which of the following drugs is MOST likely to be intentional in adults?

  • Acetaminophen

  • Ethanol

  • Antidepressants

  • Heroin

Correct answer: Acetaminophen

Acetaminophen overdoses are generally intentional in adults. It's commonly available and often used in suicide attempts due to its accessibility and perceived safety. 

Ethanol, also known as drinking alcohol, is used recreationally, and an overdose of ethanol is likely to be accidental. Antidepressants are sometimes used in intentional overdoses by individuals with depression, but this is not as common as acetaminophen. While heroin carries a high risk of overdose, most heroin overdoses are unintentional.

195.

Positive End-Expiratory Pressure (PEEP) is a method of control mode ventilation in which positive pressure is maintained during expiration to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.

If PEEP is set too high, which of the following complications is LEAST likely to occur? 

  • Flash pulmonary edema

  • Barotrauma

  • Hemodynamic instability

  • Increased work of breathing

Correct answer: Flash pulmonary edema 

PEEP delivers a consistent positive airway pressure at the end of expiration, helping to keep alveoli open and enhance oxygenation. However, elevated pressure levels may reduce cardiac output by limiting venous return, increase the effort required for breathing, and raise the risk of barotrauma.

Flash pulmonary edema, characterized by rapid onset after extubation, can arise from the abrupt withdrawal of PEEP, resulting in a significant increase in venous return. Employing a T-piece trial before extubation, especially in patients who received higher levels of PEEP during mechanical ventilation, can help prevent this issue.

196.

For a patient who remains comatose, what is the MAIN goal of therapeutic hypothermia following cardiopulmonary arrest?

  • Preserve neurologic function

  • Preserve cardiac function

  • Preserve pulmonary function

  • Preserve metabolic function

Correct answer: Preserve neurologic function

Goals of care following resuscitation from cardiopulmonary arrest are focused on minimizing brain injury and preserving neurologic function. Therapeutic hypothermia, or Targeted Temperature Management (TTM), is the only therapy that has shown improvements in neurologic recovery for patients who have sustained a cardiopulmonary arrest but remain comatose. It involves cooling the entire body to temperatures between 32°C and 36°C for at least 24 hours. TTM requires close supervision and monitoring.

197.

A new nurse wheels the crash cart into the room where procedural sedation is being provided. Knowledge of which of the following should guide the experienced nurse's response? 

  • The crash cart should be present as a precaution but is not typically used

  • The crash cart is not necessary to have present during procedural sedation

  • The crash cart is likely to be used while providing procedural sedation

  • The crash cart should be present and the patient should be attached to the defibrillator as a precaution

Correct answer: The crash cart should be present as a precaution but is not typically used

The crash cart should be present as a precaution whenever procedural sedation is being provided. However, it will be utilized only to maintain a patient's airway or hemodynamic stability, which is typically unaffected by procedural sedation. It is not necessary to attach the patient to the defibrillator as a precaution unless there is a strong indicator that cardiac dysrhythmias are likely. The crash cart is necessary because there is a higher risk of inability to maintain an airway or of hemodynamic instability during procedural sedation.

198.

A 60-year-old male presents to the emergency department with painless visible blood in his urine. Which of the following is the MOST likely cause of his hematuria?

  • Bladder cancer

  • Nephrolithiasis

  • Urinary Tract Infection (UTI)

  • Acute cystitis 

Correct answer: Bladder cancer

While UTIs, kidney stones (nephrolithiasis), and acute cystitis can cause hematuria, painless visible blood in the urine is particularly concerning for a malignancy such as bladder cancer, especially in the absence of other symptoms like pain or discomfort. 

UTIs and acute cystitis typically present with dysuria, frequency, and urgency, while renal calculi often cause severe flank pain.

199.

Which type of fracture is the result of compression force that is commonly seen in children under 10 years old?

  • Greenstick

  • Comminuted

  • Depressed

  • Transverse

Correct answer: Greenstick

Fractures occur as a result of the mechanism of injury and patient characteristics. A number of factors affect bone composition and structure, including growth and development, nutritional status, repeated trauma, hormonal changes, and disease processes, such as cancer. 

Greenstick fractures predominantly affect children, owing to their bone's greater flexibility and softness. In contrast to complete fractures, in which the bone is fully severed into two or more fragments, a greenstick fracture is characterized by an incomplete break. This means that while one side of the bone may bend and fracture, the opposite side stays intact. Such fractures usually occur in the long bones of the arms or legs and arise when the applied force surpasses the bone's capacity to bend, leading to a partial break. This injury is indicative of the difference in bone composition between children and adults: children's bones tend to bend rather than fully break due to their higher collagen content.

A comminuted fracture occurs due to intense direct force causing the bone to shatter into multiple pieces. Conversely, a depressed fracture results from blunt force impact to a flat bone, typically accompanied by significant soft tissue injury. A transverse fracture is caused by a sharp, direct force or high-energy trauma, such as an incident involving a vehicle and a pedestrian.

200.

A 59-year-old male patient presents to the emergency department with complaints of black, tarry stools and dizziness. He has a history of Peptic Ulcer Disease (PUD) and was recently treated for an H. pylori infection. His vital signs are BP 95/60 mmHg, HR 115 bpm, RR 23 breaths per minute, and temperature 36.8°C (98.2°F).

Based on the patient’s presentation, which of the following is the MOST likely cause of his symptoms?

  • Active gastrointestinal bleeding

  • H. pylori reinfection

  • Side effects of antibiotics

  • New PUD development secondary to stress

Correct answer: Active gastrointestinal bleeding

The patient's presentation of black, tarry stools (melena) and dizziness, along with hypotension and tachycardia, strongly suggests active gastrointestinal bleeding. Melena is typically indicative of upper gastrointestinal bleeding, often due to PUD. The hypotension and tachycardia indicate a significant blood loss that is compromising his circulatory status.

H. pylori re-infection is less likely to cause acute symptoms like melena and dizziness. Although H. pylori can lead to recurrent ulcers, the acute presentation points more to an active bleed than to a reinfection. Side effects of antibiotics are unlikely to cause black, tarry stools and significant hemodynamic changes. While antibiotics can cause gastrointestinal upset, they do not typically lead to gastrointestinal bleeding. New PUD development due to stress could contribute to gastrointestinal symptoms, but the acute presentation with black, tarry stools and hemodynamic instability is more indicative of an active bleed than of stress-related ulcer formation.

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